MEDICARE: LISA J PUGH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	197514	MA
2	363LA2200X	Adult Health Nurse Practitioner	197514	MA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	197514	MA
4	363LA2100X	Acute Care Nurse Practitioner	197514	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39158	OTHER	MA	HARVARD PILGRIM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	NP3032	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1821055773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA J PUGH NP

Provider Business Mailing Address
First Line	:	999 BROADWAY STE 101-I
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-4521
Country	:	US
Telephone Number	:	781-832-0035
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 BROADWAY STE 101-I
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-4521
Country	:	US
Telephone Number	:	781-832-0035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	10/04/2024

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